CY 0868 (3): Fill out & sign online

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Click ‘Get Form’ to open the CY 0868 (3) application in our editor.
Begin by entering your personal information in the 'Tell us about you' section. Fill in your first and last name, address, and contact details. If applicable, check the box indicating homelessness.
In the 'Benefits' section, indicate whether you receive any benefits such as TANF or SNAP by checking 'Yes' or 'No'.
List all household members in the designated area, including their names, dates of birth, and relationships to you. Ensure accuracy for eligibility verification.
Provide details about your children needing care. Indicate their citizenship status and select the days they require child care services.
Complete the income and expenses section by detailing all sources of income and any medical expenses incurred within the past 90 days.
Finally, review your entries for completeness and accuracy before signing the affidavit on page 7 to validate your application.

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